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Conceptual unclarity has surrounded psychotherapy research efforts to define and measure the therapeutic alliance. A precisely defined conception of the therapeutic alliance is offered that focuses on the patient's active collaboration in the tasks appropriate to the treatment process. The therapeutic alliance is thus distinguished from patient characteristics and attitudes as well as from therapist contributions to the formation of the alliance. The importance of the therapeutic alliance as a change measure in process research is underscored, and its place as a primary indicator of outcome is developed.Finally, the special relevance of the therapeutic alliance to the investigation of the therapeutic change process with borderline patients is outlined.

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The question of a cancer-prone personality has been extensively researched. Yet, few if any studies have employed a premorbid data base. Thus, nearly all evidence has been confounded, most importantly by alterations of psychological functioning due to the disease itself. This study provides a more equitable test of the cancer proneness hypothesis. A total of 200 premorbid Minnesota Multiphasic Personality Inventory (MMPI) records were collected from male cancer (n = 75) and noncancer (n = 125) patients of a Veterans Administration hospital. We reasoned that the hypothesis of the existence of psychologically related cancer proneness would gain some support if stepwise discriminant function analysis of the MMPI scores yielded a significant discrimination between the cancer and noncancer groups. Results supported this contention. The group with cancer (irrespective of site) was significantly separated from the noncancer group (p = .028), primarily on the basis of lower scores on Byrne's Repression-Sensitization scale (i.e., greater repression) and on the Depression scale of the MMPI (i.e., less self-report of depression). These results are discussed in terms of their theoretical, heuristic, and clinical relevance.

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